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EMR Interoperability 2020 EMR Interoperability 2020
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EMR Interoperability 2020
Market Progresses, but No Vendor Has Mastered It All

author - Coray Tate
Coray Tate
author - Emily Paxman
Emily Paxman
December 22, 2020 | Read Time: 8  minutes

In this update to KLAS’ 2017 interoperability research, KLAS takes a close look at how healthcare organizations perceive their EMR vendors’ efforts to help them achieve meaningful EMR interoperability. While all vendors have room to improve, some have proven more willing to work with other EMR vendors, have been more successful in enabling record exchange that impacts patient care, and have done better at providing and supporting meaningful API connections. 

four stages of interoperability

Vendor Support for EMR Interoperability

Bottom Lines on Vendor Support

Allscripts Sunrise/TouchWorks: Sunrise customers’ satisfaction with data exchange has improved significantly. Success is largely determined by customer effort. dbMotion is a key component of Allscripts’ interoperability strategy; those who devote resources to leveraging it see improved exchange of outside records, while others are frustrated by the amount of work required. Customers who haven’t purchased dbMotion leverage other sharing methods. TouchWorks customers have not seen similar progress.

athenahealth: Proactive about making connections and removing exchange barriers. Has not been as proactive in driving customer success with the ingestion of patient records. Customers leverage athenahealth APIs less frequently but consistently find value when they do.

Cerner: Significant progress with deep interoperability. Broadest use of APIs. Customers feel much of the effort to make Cerner’s interoperability tools work falls to them. Respondents starting to see Cerner be more proactive; recent improvements have been made in facilitating connections and presenting data to clinicians.

eClinicalWorks: Vast majority of customers report vendor makes interoperability harder; seen as not responsive to requests and overly cautious after legal challenges. Customer base reports increase in deep interoperability despite vendor being largely hands-off.

Epic: Long history of Epic-to-Epic sharing benefits large communities of customers. Leader in patient-record sharing—almost all customers report access to outside data; nearly two-thirds achieve deep interoperability. Most customers see Epic as an active partner in interoperability. Most progressive customers are challenging Epic to move more quickly on APIs.

Greenway Health: Customers say leadership changes and regulatory enforcement have decreased interoperability focus. They feel Greenway does the bare minimum to meet interoperability requirements and isn’t pushing forward. Intergy clients report less deep interoperability in 2020 than Prime Suite clients did in 2017.

MEDITECH: Despite lack of deep interoperability, customers are satisfied with their status and not pushing to do more. MEDITECH seen as attentive and reactive to customer needs, but not proactive in removing barriers or pushing interoperability. Expanse generally perceived positively but not propelling interoperability forward.

NextGen Healthcare: Major increase in customer satisfaction with access to outside records. Customers see increased focus on patient-record sharing and say NextGen is leading them forward. Deep interoperability is flat from 2017—customer adoption of functionality NextGen releases is still low.

how often does your emr vendor make interoperability harder
vendor support of interoperability 2017 vs 2020

Achieving Deep Interoperability

industry progress toward deep interoperability and percent of customers achieving deep interoperability

Epic Emerges as Clear Leader in Patient-Record Sharing; Cerner Makes Significant Strides; eClinicalWorks Customers Driving Their Own Progress

Epic is the first vendor to make significant progress toward ubiquitous patient-record sharing. Almost 100% of customers report data is available, and two-thirds report it impacts care (i.e., deep interoperability). Records from exchange partners are presented fairly automatically, allowing clinicians to make better use of data at the point of care. This success is tied to satisfaction improvements with outside-record sharing and increased participation in Carequality, as well as Epic’s proactive approach to progressing interoperability. Both Epic and non-Epic customers feel the vendor’s commitment to outside sharing has grown. Cerner has made notable progress on deep interoperability—in 2020, nearly four times as many customers report deep interoperability than in 2017. This progress comes from significant improvements to how fluidly records are presented in the clinical view. Increasingly, records are fully integrated or in a separate EMR tab. Another contributing factor is increased use of CommonWell. When it comes to making initial connections to outside EMRs or national networks, customers have started to see more proactivity from Cerner; in the past, organizations didn’t see much progress without investing significant internal effort. Deep interoperability increases from eClinicalWorks clients are smaller but notable. Once customers can easily locate records, they have great success presenting the data to clinical users and driving a meaningful impact on patient care. Improving users’ ability to locate records could significantly impact deep interoperability. Customers feel interoperability could be further improved if eClinicalWorks were more proactively engaged in the integration process and innovating faster.

MEDITECH and Greenway Health Not Facilitating Progress amid Platform Transitions; dbMotion Not a Silver Bullet for Allscripts Customers

Legacy MEDITECH customers that migrate to Expanse aren’t seeing resulting interoperability gains. The transition is largely considered to be positive, but customers are left to drive interoperability on their own and, right now, are mainly focused on getting the new platform up and running and learning how to leverage product workflows. Greenway Health customers interviewed in this year’s research mainly use Intergy, while past research included mostly Prime Suite users. Some customers that have shifted from Prime Suite to Intergy have seen a step backward in terms of deep interoperability. Greenway Health’s progress has been hindered by frequent leadership turnover, other areas being prioritized over development, and lack of internal expertise. For Allscripts customers, getting initial access to electronic records is a challenge but possible with enough internal effort. dbMotion has improved exchange with non-Allscripts EMRs, but this federated approach means there aren’t significant advantages for same-vendor exchange. Clinicians struggle to parse through data to find what they need.

Taking a Step toward Electronic Access: NextGen Improves Significantly, athenahealth Stalls as Customer Complexity Grows

Success connecting to EMRs is the first, foundational step toward deep interoperability. NextGen Healthcare has made major strides in this aspect. All interviewed customers are satisfied with the smooth process for same-vendor exchange. Organization leaders say they rarely hear complaints from users. When it comes to sharing with other vendors, customers feel NextGen is committed to their success. These improvements have had a notable impact on electronic access. However, NextGen is not yet a deep interoperability leader; sometimes data is presented within the EMR, but sometimes it is presented through portals outside the EMR. If this barrier is overcome, the vendor is poised for significant improvement. athenahealth’s customers are trying to connect to more outside systems than in previous years. These often large, increasingly complex organizations note several barriers that prevent athenahealth from meeting their rising expectations, including the amount of effort required to locate records and difficulty incorporating records from many disparate systems. athenahealth-to-athenahealth sharing is smooth and “just happens.”

What about Same-Vendor Exchange? | Past KLAS reports have shown that most vendors achieve a high degree of deep interoperability when it comes to customers exchanging data with organizations using the same EMR. This year, Epic and athenahealth customers continued to report a high degree of satisfaction. Cerner, NextGen Healthcare, and MEDITECH customers are starting to see more progress; Cerner customers would like the vendor to be more proactive. Allscripts, eClinicalWorks, and Greenway Health customers feel their vendor still has a ways to go.

Adoption and Value of APIs

Cerner Customers Using APIs Most Broadly; Epic Making Careful, Steady Progress

api adoption rate by use case

With the market as a whole in early stages of API adoption, Cerner stands out, especially for FHIR APIs. Customers report Cerner has been working to promote more openness, and large customer organizations have been pushing the needle. The primary API use cases for Cerner customers are patient record exchange and clinician-enabling tools. These use cases offer additional avenues to interoperability but have yet to truly advance deep interoperability (i.e., impacting patient care). The perceived value of Cerner’s APIs could be increased if Cerner were in the driver’s seat; today customers often feel their own organizations are driving progress forward. Epic has been fairly selective about what vendors they will work with to connect, slowing progress. Available APIs (mainly proprietary rather than FHIR) frequently drive meaningful outcomes for customers. These outcomes are mostly clinical; some customers report improved operational efficiency. In general, APIs are less of a focus for Epic; while the vendor is willing to help customers set up these connections, they aren’t leading out.

athenahealth and NextGen Use of FHIR APIs Is Limited but Drives Value

Most vendors are generally meeting customers’ expectations for driving adoption and achieving meaningful exchange from proprietary APIs. FHIR APIs, partly due to their relative newness, generate more significant differences between vendors. Use of APIs among athenahealth customers is not as broad as among some other customer bases, but what they are doing is driving value. Perceptions of value are largely driven by the fact that athenahealth is putting in a lot of work, tipping the effort-to-value ratio to the benefit of customers. athena’s communication with both customers and third-party vendors and their willingness to own issues brought to them are noted as strengths. NextGen Healthcare customers have primarily adopted proprietary APIs, with only some using FHIR for patient-record exchange. Customers say NextGen Healthcare’s proactive help has led them to feel they are deriving value from APIs. Some eClinicalWorks customers indicate the vendor has been hesitant to go down the FHIR APIs road and has only made progress because of federal law. eClinicalWorks’ lack of technical expertise is a barrier to achieving meaningful API connections.

fhir api adoption vs satisfaction

commonwell carequality reportA common sharing method not covered in this report is national networks—namely, CommonWell and Carequality. For insights on EMR vendors’ progress enabling sharing via these networks, see KLAS’ latest report on the topic.

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. Two types of interviews are conducted: (1) standard quantitative evaluations, from which scores and commentary collected are shared online in real time so that other providers and IT professionals can benefit from their peers’ experiences, and (2) supplemental evaluations that target a subset of KLAS’ overall sampling and delve deeper into the most pressing questions facing healthcare technology today.

The data in this report comes from supplemental evaluations only and was collected over the last 12 months; the number of unique responding organizations is given in the chart below.

about this report

What Does “Limited Data” Mean?

Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size may vary from question to question and may not reach KLAS’ required threshold of 15 unique respondents. When a vendor’s sample size for a particular question is less than 15, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

author - Amanda Wind Smith
Amanda Wind Smith
author - Natalie Jamison
Natalie Jamison
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.